The epidemiology of ocular injuries among patients presenting to provincial hospitals in KwaZulu-Natal, South Africa.

Abstract

Purpose: Ocular injuries are increasingly becoming the permanent cause of visual blindness (Mufti et al, 2004). Most of the previous studies in this area are done in countries outside the African context. A limited number of general surveys in ocular trauma appear in the ophthalmic literature in South Africa. The purpose of this study was to provide epidemiological data on ocular injuries among patients utilising the provincial hospitals eye services in KwaZulu-Natal, South Africa. Methods: A quantitative retrospective study design was carried out by collecting data on 660 patient’s record cards with ocular injuries presenting to four selected provincial eye care clinics for a four year period (January 2005-December 2008). Using a data sheet devised for capturing of the information, the following data was retrieved: (i) demographics details, (ii) place of trauma (iii) nature of trauma, (iv) type of injury, (v) management and (vi) visual outcomes following primary eye care. All patients who presented to the eye clinics with ocular injuries within the specified four years, both genders, all race groups and all age groups were included in the study. Results: There were 440 patients’ records reviewed at rural hospitals and 220 at urban hospitals. Males were more likely than females to have ever experienced an eye injury (72.3% versus 27.7%, respectively) and urban males were more likely than rural males to incur an eye injury (79.1% versus 68.9%, respectively). The Black population has a higher prevalence of ocular injuries than other race groups: Blacks 93.8% followed by Indians 3.9%, Coloureds 2% and the least in Whites 0.3%. Over one-third of all the patients were between 21 and 30 years old with second highest percentage of patients being in the age category of 31 to 40 years. A significant percentage of patients were children (13.8%) up to the age of 12 years. Open globe injuries were more frequent (56.2%) than closed globe injuries (43.8%). Blunt trauma/contusion was the most frequent type of injury (35.2%). More than half of patients (50.9%) had associated ocular signs with the predominance of haemorrhages (15.9%). The majority of the patients presenting with ocular signs had incurred blunt trauma (54%). Only 3.5% of all injuries were bilateral and 96.5% were unilateral.

Solid objects were responsible for more than half of the injuries (54.4%) occurring either in the home or at work, followed by assaults (24.3%) and chemical burns (6.2%). Three percent of patients’ records (n=17) had substance (alcohol) abuse documented. The home accounted for the majority of the eye injuries (60.6%) followed by the social environment (15.2%), workplace or industry (13.6%), commercial workplace and agriculture had the same number of injuries (4.1%) and sports or leisure facilities (2.4%). The home remained the single most frequent place for an injury to occur across all age groups, highest in the 21 to 30 age group (26.8%, n=107) followed by 21.3% (n=85) in the 0 to 12 age group. Thirty patients (4.5%) required surgical intervention at initial presentation. Three hundred and forty patients (51.5%) returned for follow up examination. Only 9 (9.2%) patients with initial poor vision (<6/60) achieved 6/12 or better visual acuity after treatment. In 17 (38.6%) patients, visual acuity remained the same as initial visual acuity (6/15-6/60) and got worse in 5 (7.8%) patients (<6/60). Twenty six (59.1%) patients achieved between 6/15-6/60 vision after presenting with poor vision and 59 (92.2%) remained with poor vision after treatment. Conclusion: Ocular trauma is a relatively common problem in the province of KwaZulu-Natal, occurring most frequently in young adults and males warranting presentation to the eye casualty department for treatment. Ocular trauma is usually unilateral, but can also be bilateral and this remains a significant major public health problem. People engaged in agriculture, in industry, in the home, in the social environment, in sports and people living in rural communities are at highest risk. This warrants specific, targeted, prevention measures to be put in place to minimize the incidence of visually damaging trauma.